Factors that influence flow through intravascular catheters: the clinical relevance of Poiseuille's law.
Journal
Transfusion
ISSN: 1537-2995
Titre abrégé: Transfusion
Pays: United States
ID NLM: 0417360
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
17
02
2020
revised:
17
04
2020
accepted:
20
04
2020
pubmed:
10
7
2020
medline:
23
6
2021
entrez:
10
7
2020
Statut:
ppublish
Résumé
The physics of ideal fluid flow is well characterized. However, the effect of catheter size, tubing types, injection port adjuncts, and viscosity on flow is not well described. We used a simulated environment to determine how various permutations of common elements affect fluid flow. We tested 16 peripheral and central venous catheters to assess flow through several standard infusion sets and a rapid infuser set; tested flow through standard and blood infusion sets with the addition of intravenous extension tubing, stopcocks, and a needleless connector; and compared the relative viscosity of commonly used blood products and colloids to that of normal saline. The maximal flow rate was 200 mL/min for the standard infusion set but 800 mL/min for the rapid infusion set. Choice of infusion tubing was the rate-limiting component for many larger catheters. A 14-gauge, single-lumen central venous catheter (CVC) and 18-gauge peripheral intravenous catheter (PIV) had equivalent flow rates with all infusion sets. A 16-gauge single-lumen CVC allowed a flow rate that was slower than that of a 20-gauge PIV, and faster than that of a 22-gauge PIV. The addition of adjuncts slowed flow rate. Needleless connectors had the greatest impact, reducing flow by 75% for the blood infusion set. Packed red blood cells had a viscosity 4.5 times that of normal saline and thereby reduced flow. Catheter and tubing choice, adjuncts, and fluid viscosity influence flow rates. Our results will help inform adequate vascular access planning in the perioperative environment.
Sections du résumé
BACKGROUND
The physics of ideal fluid flow is well characterized. However, the effect of catheter size, tubing types, injection port adjuncts, and viscosity on flow is not well described. We used a simulated environment to determine how various permutations of common elements affect fluid flow.
STUDY DESIGN AND METHODS
We tested 16 peripheral and central venous catheters to assess flow through several standard infusion sets and a rapid infuser set; tested flow through standard and blood infusion sets with the addition of intravenous extension tubing, stopcocks, and a needleless connector; and compared the relative viscosity of commonly used blood products and colloids to that of normal saline.
RESULTS
The maximal flow rate was 200 mL/min for the standard infusion set but 800 mL/min for the rapid infusion set. Choice of infusion tubing was the rate-limiting component for many larger catheters. A 14-gauge, single-lumen central venous catheter (CVC) and 18-gauge peripheral intravenous catheter (PIV) had equivalent flow rates with all infusion sets. A 16-gauge single-lumen CVC allowed a flow rate that was slower than that of a 20-gauge PIV, and faster than that of a 22-gauge PIV. The addition of adjuncts slowed flow rate. Needleless connectors had the greatest impact, reducing flow by 75% for the blood infusion set. Packed red blood cells had a viscosity 4.5 times that of normal saline and thereby reduced flow.
CONCLUSION
Catheter and tubing choice, adjuncts, and fluid viscosity influence flow rates. Our results will help inform adequate vascular access planning in the perioperative environment.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1410-1417Informations de copyright
© 2020 AABB.
Références
Jayanthi NV, Dabke HV. The effect of IV cannula length on the rate of infusion. Injury 2006;37:41-5.
Iserson KV. The origins of the gauge system for medical equipment. J Emerg Med 1987;5:45-8.
Ahn W, Bahk JH, Lim YJ. The “gauge” system for the medical use. Anesth Analg 2002;95:1125.
Osborn NK, Baron TH. The history of the “French” gauge. Gastrointest Endosc 2006;63:461-2.
Gauge - French Conversion. www-users.med.cornell.edu/spon/picu/calc/gafrconv.htm. Published 2010 [accessed 2019 Mar 11].
Caballero JA, Rivera F, Edwards J, et al. Pressure-rated needleless access connectors slow IV flow rate. Anesth Analg 2010;111:1077-8.
Lehn RA, Gross JB, McIsaac JH, et al. Needleless connectors substantially reduce flow of crystalloid and red blood cells during rapid infusion. Anesth Analg 2015;120:801-4.
Comunale ME. A laboratory evaluation of the level 1 rapid infuser (H1025) and the Belmont instrument fluid management system (FMS 2000) for rapid transfusion. Anesth Analg 2003;97:1064-9.
Wrenn EA, Wohlers R, Montgomery M, et al. Comparison of flow dynamics of peripherally and centrally inserted intravenous catheters using a rapid infusion system (ThermaCor 1200). AANA J 2017;85:256-60.
Barcelona SL, Vilich F, Cote CJ. A comparison of flow rates and warming capabilities of the Level 1 and Rapid Infusion System with various-size intravenous catheters. Anesth Analg 2003;97:358-63.
Khoyratty SI, Gajendragadkar PR, Polisetty K, et al. Flow rates through intravenous access devices: an in vitro study. J Clin Anesth 2016;31:101-5.
Aeder MI, Crowe JP, Rhodes RS, et al. Technical limitations in the rapid infusion of intravenous fluids. Ann Emerg Med 1985;14:307-10.
Noirot MT, Freysz M, Letourneau B, et al. Technical constraints in rapid vascular fluid replacement. Ann Fr Anesth Reanim 1990;9:433-42.
Millikan JS, Cain TL, Hansbrough J. Rapid volume replacement for hypovolemic shock: a comparison of techniques and equipment. J Trauma 1984;24:428-31.
Landow L, Shahnarian A. Efficacy of large-bore intravenous fluid administration sets designed for rapid volume resuscitation. Crit Care Med 1990;18:540-3.
Dutky PA, Stevens SL, Maull KI. Factors affecting rapid fluid resuscitation with large-bore introducer catheters. J Trauma 1989;29:856-60.
Hu MH, Chan WH, Chen YC, et al. Effect of external pressure and catheter gauge on flow rate, kinetic energy, and endothelial injury during intravenous fluid administration in a rabbit model. Shock 2016;45:98-103.
Kamata M, Walia H, Hakim M, et al. An in vitro assessment of the efficacy of various IV cannulas for the rapid IV fluid administration. Pediatr Crit Care Med 2017;18:e224-8.
Iserson KV, Criss E. Combined effect of catheter and tubing size on fluid flow. Am J Emerg Med 1986;4:238-40.
Elad D, Zaretsky U, Heller O. Hydrodynamic evaluation of intravenous infusion systems. Ann Emerg Med 1994;23:457-63.
Russo PL, Harrington GA, Spelman DW. Needleless intravenous systems: A review. Am J Infect Control 1999;27:431-4.
Wilcox GJ, Barnes A, Modanlou H. Does transfusion using a syringe infusion pump and small-gauge needle cause hemolysis? Transfusion 1981;21:750-1.
Calkins JM, Vaughan RW, Cork RC, et al. Effects of dilution, pressure, and apparatus on hemolysis and flow rate in transfusion of packed erythrocytes. Anesth Analg 1982;61:776-80.
Saw S, Arendts G. The effect of the InterLink cannula on fluid flow rates and haemolysis. Emerg Med (Fremantle) 2001;13:456-9.
Philip BK, Philip JH. Prediction of flow capability in intravenous infusion systems: implications for fluid resuscitation. J Clin Monit 1990;6:113-7.
Semple JW, Rebetz J, Kapur R. Transfusion-associated circulatory overload and transfusion-related acute lung injury. Blood 2019;133:1840-53.
Guisto JA, Iserson KV. The feasibility of 12-gauge intravenous catheter use in the prehospital setting. J Emerg Med 1990;8:173-6.